Going after HMOs Punitive bills: Unpopular insurers target of efforts to restrict decision-making powers.

March 20, 1998

HEALTH MAINTENANCE organizations make for easy villains

in the legislative hallways of Annapolis. The HMOs' objective is to hold down health-care costs, which has angered powerful physician groups and also infuriated consumers who have run into irrational penny-pinching by managed care providers.

Once again, HMOs are trying to fend off punitive bills aimed at stripping them of decision-making powers over medical treatment. The HMOs claim the dispute is over money, specifically the reduced fees paid to physicians, who are leading the charge to rein in HMOs. The doctors maintain it is a matter of letting the experts make the medical decisions.

It is a delicate balancing act involving affordable health care and quality medical care. But the HMOs are primarily insurance companies. Their main focus is the bottom line. That has driven some consumers to despair over HMO decisions that restrict or deny health-care treatment that is truly needed.

Legislators, though, ought not to go too far in trying to bring accountability and humanity to HMO decision making. A Senate panel has heavily amended a bill so that it punishes managed-care groups, making HMO medical directors fat targets for lawsuits and giving a board controlled by the state doctors' group power to go after HMO medical directors who try to impose fiscal discipline on physicians.

A far better, and more reasonable, approach came within an eyelash of passing last year. It would require HMO medical directors to be certified by the state insurance commissioner, who could punish both the director and the HMO for irresponsible actions. That approach, or a similar version, would hold the HMOs' feet to the fire and give consumers a prompt grievance process to protest unreasonable HMO treatment decisions.

Pub Date: 3/20/98

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